POST-BIRTH RECOVERY

After you have given birth it is normal to feel quite strange, both physically and emotionally. You may miss your ‘bump’, and becoming a mom can be a major adjustment for some women. On the physical side, you will still have a ‘tummy’, your uterus will continue to contract, you will have heavy bleeding and your breasts might be hard and sore. Added to this, plunging hormone levels may make you feel very emotionally unstable. But relax…it’s all part of the process and your body will soon recover.

Here are some of the normal TEMPORARY post-delivery issues you can expect to face:

Afterpains – Strong pains in your stomach, similar to period pains, immediately after your baby is born. These are caused by the release of oxytocin, the hormone that brings on labour contractions. After birth, oxytocin works to shrink your uterus and reduce bleeding. It is also released during breastfeeding, so your uterus will shrink even faster if you breastfeed. If you do need pain relief, ibuprofen and paracetamol are safe (even if breastfeeding) but aspirin should be avoided as it can increase bleeding.

Lochia – A discharge of blood, mucous and uterine tissue after you’ve given birth. It will initially be very heavy, especially when you get out of bed and when you breastfeed. Lochia can last up to 6 weeks, but the flow will slowly become much lighter. Make sure you use maternity pads and not tampons to absorb the discharge.

Soreness and swelling in the genital area – If you had a long labour, a vaginal delivery and/or stitches, you may have quite a lot of pain and your perineum may be quite numb. Throw a handful of coarse salt into your bathwater to promote healing of small tears and stiches, and use an ice pack to bring down the swelling. It is very important to keep your genital area really clean to prevent infection. Pelvic floor exercises will help you regain your muscle tone, increase circulation in the area and reduce perineal pain. It is vital that you empty your bladder within 6-8 hours of delivery to avoid urinary tract infections and prevent your bladder from becoming distended. Remember to drink plenty of water and eat lots of fibre – whole grains and fresh fruit and vegetables – to help stimulate your bowels and prevent constipation.

Full, hard breasts – This will happen 2-4 days after giving birth, whether you breastfeed or not, as hormones are secreted which prepare the breasts for breastfeeding. It is called engorgement and can be very painful, but there is lots you can do to ease the short-term discomfort. Wear a supportive bra day and night; take a warm shower just before breastfeeding to dilate the milk ducts; or apply a warm compress to your breasts. If you aren’t breastfeeding, try using a cool compress on your breasts and take paracetamol or ibuprofen to relieve pain. (Do not express milk as this will result in further milk production.)

Leaking breasts – This can be a bit embarrassing so wear breast pads to absorb any leaking milk and clothes that camouflage milk stains. Try not to go too long between feeds and express some milk if your breasts do become too full.

Tender nipples – It’s normal to have some tenderness at the start of feeds in the first week or two. After this, incorrect attachment is usually the cause. When you need to take your baby off your breast, do it carefully by breaking the suction with your little finger in the corner of your baby’s mouth. It’s a good idea to let your nipples get some air after each feed. Allowing breastmilk to dry on your nipples is also useful as it has antiseptic properties. Avoid using drying agents like soap on nipples, and be sure to change your breast pads when they are wet.

Skin changes – Changing hormone levels after the birth may make your skin drier, more sensitive and more prone to pimples and breakouts. Skin pigmentation from pregnancy should slowly fade but some may never totally disappear. Avoid excessive sun exposure and protect your skin with a good sunscreen. Stretchmarks should fade over time and some creams and oils may slightly reduce their appearance.

Sweating – You will sweat a lot more than normal after the birth as your body gets rid of the extra fluids built up during pregnancy. This can persist for up to 6 weeks and breastfeeding (which increases your metabolism) will further increase sweat production. Drink lots of water and wear natural fibres that allow your skin to breathe.

(also see “Feeding”)

What can I do about cracked nipples?

Incorrect attachment is often the cause, so follow the suggestions for tender nipples. If it is too painful to breastfeed, avoid feeding on the sore breast for 12-24 hours but express milk during this period. Put expressed breastmilk on nipples after feeds to promote healing.

What can I do about a blocked milk duct?

Blocked milk ducts appear as a hard, tender lump that may or may not be red. Feed your baby as often as possible, starting with the affected breast, and gently massage the lump towards the nipple while your baby is feeding to help clear the blockage. Start each feed on the affected side for 2-3 consecutive feeds to help the breast drain. Then offer the second breast or express for comfort. It is best to have your baby’s chin pointing towards the blocked duct to improve drainage of the affected area. If feeding has not reduced the lump, gently massage toward the nipple while hand expressing. Also check your bra is not too tight and remove during feeds if you prefer. Sleep without a bra as much as possible. If a blocked duct persists longer than 12-24 hours seek help from a healthcare professional.

What is mastitis and what can I do about it?

Mastitis is an inflammation of breast tissue. Symptoms can include all or some of the following: inflammation of the breast; hot, red, painful breast; and flu-like symptoms (fever, headaches and aching joints). If you have mastitis, continue to breastfeed and follow the suggestions for blocked ducts. You should also see your GP immediately for antibiotics. Rest and drink plenty of fluids. Remember: Drainage of the affected breast is very important. Check your attachment is correct.

Urinary incontinence – This is common after a vaginal delivery and may last a few weeks or months. Stress incontinence (leaking urine when you cough, sneeze or jump) occurs frequently and can last up to a year after delivery, but usually improves over time. Wear sanitary pads to prevent leaks and do regular pelvic floor exercises. It may take a while to see any improvement in bladder control, but persevere. See your doctor if the problem persists longer than a year or seriously affects your lifestyle.

Hair loss – It is normal for your hair to fall out quite rapidly after the birth. This is because hormones during pregnancy slow the normal cycle of hair loss significantly, which means that for a while after birth you will lose all the hairs that would have fallen out during pregnancy. Regrowth can’t initially keep up with the loss, making hair look thinner than usual, but your hair will resume its normal pattern after about 6 months. In the meantime, eat healthily and be gentle with your hair. Only wash your hair when necessary, use a mild shampoo and a nourishing conditioner, and avoid using heated appliances on your hair.

Back pain – This is normal as your back has had to support the extra weight of your growing baby and make up for your weaker abdominal muscles. The hormone relaxin has also loosened ligaments and joints, and your changed centre of gravity has caused you to lean back more, putting pressure on your back and making you more prone to backache. After giving birth, be careful not to strain your back by lifting incorrectly. Bend at the knees and not at the waist, with feet shoulder-width apart. Put the weight on your arms and legs not your back. Be conscious of your posture and walk, sit and lie with your bottom tucked under and your stomach pulled in. Sleep on a firm mattress and make sure the handles of your pram are at a comfortable height for you. Also try to lose excess weight gained during pregnancy by exercising and eating a healthy diet.

Prolapse – If the pelvic floor muscles have been weakened by a rapid delivery, long labour or a very large baby, they can sometimes fail to support the uterus in its normal position, causing it to drop down into the vagina. Other organs such as the bladder, urethra, rectum and abdominal lining can also drop, put pressure on the vagina, and cause vaginal prolapse or vaginal wall descent. You may experience a dragging sensation and a heaviness in the lower abdomen, leaking urine when sneezing or coughing, pain in the lower abdomen or back, constipation and uncomfortable or painful sex. Start pelvic floor exercises as soon as possible after birth to help to prevent a prolapse. A high fibre diet will prevent constipation and straining, which put further pressure on the pelvic floor. See you doctor if your prolapse is becoming difficult to live with.

A Caesarean is major abdominal surgery, so try to take it easy while you recover. You will also experience all the same post-birth discomforts as you would after a vaginal delivery – afterpains, lochia (bleeding), breast fullness, fatigue, hair loss, excessive perspiration and possibly baby blues and exhaustion. Don’t worry – things will soon improve!

It takes longer to get over a spinal or epidural block than a general anaesthetic. Numbness wears off from the toes up, so wiggle your toes and move your feet as soon as you can. If you had a spinal block you will have to remain flat on your back for 8-12 hours.

Your incision will hurt when the anaesthetic wears off, so take the prescribed pain medication.

Try to get out of bed between 8 and 12 hours after surgery. Take it slowly and remember that difficulty in getting around is temporary.

Your catheter will be removed after 24 hours and you may have wind pains on day 2 or 3. You may be told to walk up and down or lie on your side/back with your knees up to ease the discomfort. Once you are moving and eating normally, your bowel activity will slowly go back to normal.

Wear support stockings to improve circulation and prevent blood clots in your legs.

Your cut should heal in about a week. Check it daily and call your doctor straight away if you notice any inflammation or pus-like drainage. You can wash the area with mild soap, rinse well and pat it dry after the dressing is off. The internal incision takes about 6 weeks to heal.

Avoid heavy lifting, driving or returning to work until you have had your check-up, usually in 4-6 weeks.

Your periods will probably resume 4-6 weeks after delivery if you are not breastfeeding, and may begin around the same time even if you are. Menstrual flow can be light to rather heavy for the first few cycles but should become more consistent after that.

You will start to ovulate before your first period after childbirth, so you should use some form of contraception to prevent an unplanned pregnancy. You can start taking birth control pills 2-3 weeks after the birth if you are not breastfeeding. If you are breastfeeding, take a progesterone-only pill as oestrogen-based pills can affect milk production. Do not use any internal barrier methods of contraception before your cervix is fully healed or if you have had stitches.